NEW ORLEANS -- Just days after St. Bernard Parish took similar action to address prescription drug abuse, the New Orleans City Council on Thursday passed a moratorium against pain-management clinics in two districts.
A citywide moratorium could be in place by early May.
One state lawmaker said the abuse of prescription drugs is so serious a state law is needed to better regulate the clinics.
There are an estimated 60 drug-overdose deaths a year in Orleans Parish. St. Tammany Parish reports 56 overdose deaths in the past three years. St. Bernard Parish reports more than 60 overdose deaths in the past two years.
Fritz Windstein has operated a pain management clinic since 2003. He said on average, the clinic treats about 20 patients a day for chronic pain.
"We routinely drug-test people in here," he said. "About every five visits you get drug-tested. If we find you're taking something else, it's like, 'Sorry, we can't see you anymore.'"
State Rep. Austin Badon Jr. said the recent moratoriums aren't enough.
"We've identified at least 12 clinics out in New Orleans East, where I represent, and there are many more in New Orleans. This is not just a New Orleans problem -- it affects the surrounding areas."
Badon plans to form a taskforce to investigate drug abuse by pain clinic patients and eventually introduce a state law to better regulate the clinics.
"They're doing a tremendous disservice to the community, because they inundate the community with drugs, and they're making people more addicted to narcotics."
Windstein said while he tries to police his patients, it is difficult, and he would welcome assistance from city, parish or state lawmakers.
"We are not the only source of drugs on the streets," he said.
Badon said he plans to have a law before legislators by this time next year.
They're accused of running 'pill mill'
Wednesday, April 13, 2005
By Michael Perlstein
Staff writer
Doctor's visits as brief as 11 seconds. Preprinted prescriptions doled out in assembly-line fashion to hundreds of patients in a day, many of them with no medical problems. Pharmacies in which up to 88 percent of first-time customers in a single day presented identical prescriptions written by the same physician.
Those are some of the allegations made by federal authorities against a nurse and three local doctors who were arrested Tuesday in a sweeping investigation that accuses them of running a highly lucrative "pill mill," dispensing dangerous and addictive narcotics to just about anybody who complained of aches and pains, some real, some made up.
At dawn, agents with the Drug Enforcement Administration arrested the owner and operator of the clinics, Cherlyn "Cookie" Armstrong, at her Eastover home. Armstrong, 45, runs three clinics operating as Scherer's Medical Center, an outgrowth of a string of weight loss clinics that she started in the 1990s. She is a registered nurse who is still facing state narcotics charges in Slidell for allegedly dispensing drugs in 2000 without a doctor's oversight, authorities said.
Agents also arrested three of Armstrong's staff doctors, sending a seismic wave through the local medical community, especially those involved in pain management, a controversial new specialty that has mushroomed in the past few years to include more than 60 pain clinics in the metro area. The unchecked proliferation of pain management clinics, along with allegations of shady practices geared at maximizing profits, recently sparked moratoriums against such clinics in Orleans, St. Bernard and St. Tammany parishes.
The doctors who were arrested Tuesday -- Betty De Loach, 66, of Kenner; Suzette Cullins, 43, of New Orleans; and Joseph Guenther, 71, of Metairie -- were ordered along with Armstrong to remain in jail overnight until detention hearings can be held today. The government has asked that the defendants be held without bail indefinitely because they might be flight risks. Federal authorities immediately sought suspension of the licenses of the doctors, clinics and pharmacies involved in the case, local DEA chief William Renton said.
Millions in cash
The DEA, aided by the FBI, Internal Revenue Service and local police agencies, also confiscated more than $10 million in assets. Of that total, $4 million was frozen in 17 of Armstrong's bank accounts, acting U.S. Attorney Jim Letten said. Another $1.6 million was found in Armstrong's home, much of it in stacks of hundred-dollar bills stashed in safes, cans and garbage bags.
In the criminal complaint, supported by a 65-page affidavit outlining the details of the yearlong probe, each defendant faces a charge of conspiracy to illegally distribute controlled substances. Armstrong and Cullins face an additional charge of distributing controlled substances to people younger than 21. Both drug charges carry a five-year maximum prison sentence. Armstrong also faces a money-laundering charge, which carries up to 10 years.
Letten noted that 16 others, including doctors and pharmacists, are listed by their initials in the affidavit as employees or participants in Armstrong's operation. Several of the people listed are members of Armstrong's family, including her husband, Steven Prejean, a lawyer who is co-owner of the clinics.
"This investigation is by no means over," Letten said. "In fact, this is really very much the beginning of a second, much more active phase. . . . I can tell you we're looking at everyone involved with these clinics."
After the arrests, agents raided Scherer's clinics in Metairie, Gretna and Slidell, loading U-Haul trucks with boxes of records. In Metairie and Slidell, steady streams of cars crept past the clinics, some circling the block amid the commotion, others speeding away. Agents questioned the persistent drivers who pulled into the parking lots of the clinics and arrested more than two dozen of them on unrelated charges such as possession of marijuana, possession of illegal pharmaceuticals and outstanding warrants.
In addition, agents raided four pharmacies, two of them owned by Armstrong and located next to her Metairie and Slidell clinics. The other two pharmacies that were raided and shuttered are The Medicine Shoppe in Slidell and Michael's Discount Pharmacy in Kenner. Armstrong's pharmacies, which operate under the name "Mia's," sport the storefront sign "Medicine in a Snap."
That logo is the perfect description of what took place inside the clinics, Renton said.
"This operation was a sham to make money by dispensing narcotics regardless of whether there was any medical necessity," he said.
A tight schedule
The affidavit is full of allegations that support Renton's characterization:
-- The clinics accepted only cash, $220 for an initial visit and $80 for each follow-up visit. The associated pharmacies also operated on a cash-only basis, charging $40 for the most commonly prescribed pill regimen: hydrocodone (most commonly sold under the brand name Lorcet), alprazolam (Xanax) and carisoprodol (Soma). The combination is known on the street as the "holy trinity" or "cocktail."
-- The clinics are run "with the express goal that each full-time doctor will see 700 patients per 35-hour work week, i.e. one patient every 3.3 minutes," the affidavit states.
-- While patients were usually prescribed a two-week supply of pills, many patients amassed much more than that by visiting different clinic locations on different days of the week. This practice is referred to in the affidavit as "doctor shopping."
-- The DEA used informants as well as undercover agents to make dozens of doctor's visits and high-volume purchases. Most of the visits lasted less than 60 seconds and involved little or no medical examination. In one instance, Cullins expresses concern that an informant visited her twice in four days. In the affidavit, Cullins is quoted as saying, "You need to back off from me or you need to go see Dr. Guenther when he's available. Do we have an understanding?" The visit lasted 25 seconds.
-- On a subsequent visit to Guenther a month later, the same informant brought in a clean MRI. Guenther looked at the MRI and said, "There's really nothing wrong with you. . . . I told you to see an orthopedist a long time ago. I can't do much for you." Guenther then signed a prewritten prescription for "the trinity," the affidavit alleges. The visit lasted 85 seconds.
"They're street peddlers with an M.D. after their names," said Dr. John Bobear, executive director of the state Board of Medical Examiners.
Bobear and others said unscrupulous clinics pose a dangerous double whammy: They illegally provide narcotics to addicts with no underlying medical basis, and they tarnish the work of legitimate pain management clinics that offer a range of therapies from massage to exercise to graduated doses of medicine if needed.
"Prescription drug abuse is the No. 2 class of abuse after marijuana in the United States right now," Renton said. "This is a serious, serious problem."
The defendants, handcuffed and shackled in prison-issued jumpsuits, made a Tuesday afternoon appearance before U.S. Magistrate Louis Moore Jr.
Moore ordered them to return to Orleans Parish Prison pending a hearing today at 2 p.m. to determine their bail amounts or, as requested by prosecutors, whether they will be detained until trial. Assistant U.S. Attorney Tony Sanders, the lead prosecutor on the case, said he will ask for detention for all four defendants on grounds that they are flight risks or a danger to the community. Sanders also asked Moore to order all four defendants to undergo drug tests.
Begging for bail
Armstrong's attorney, Sal Panzeca, pleaded to Moore that his 45-year-old client is the mother of a 12-year-old girl and has never been convicted of anything. He added that similar allegations were made against her a few years ago, but no charges were filed.
"No way she is a flight risk or a threat," Panzeca said.
Then Armstrong spoke up: "I'm not a flight risk. I would really like to go home to my little girl, and I'll be back tomorrow."
Neither Panzeca nor Armstrong mentioned the pending charges in Slidell, allegations that in November forced Armstrong to enter into a consent agreement with the state nursing board, according to the DEA affidavit.
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